from the Newsletter of the Multidisciplinary Association for Psychedelic
Studies
MAPS - Volume 4 Number 3 Winter 1993-94

Marijuana Water Pipe Study

Included in the Medical Marijuana Clinical Plan is a study of the
effectiveness of water pipes in filtering marijuana smoke. This project
has been mentioned in previous MAPS newsletters. The study is designed to
determine if there are safer ways than a standard marijuana cigarette to
administer the therapeutic components of marijuana, while at the same time
still retaining the advantages of smoking over the oral THC pill. These
advantages include smoked marijuana's rapid onset of effects, the
patients' ability to self-titrate their dose, and the delivery of a
complex set of constituents of the marijuana plant which may work more
effectively than THC alone. If we can demonstrate that a specific water
pipe does indeed have a beneficial advantage over a standard marijuana
cigarette, we will distribute the pipe to all AIDS patients in the wasting
syndrome study. Good news - all the funds needed for this study, $28,800,
have been successfully raised. The study will take place under the
direction of Dr. Hoffman at the Institute for Smoking and Health in New
York. This study is possible primarily because MAPS received a grant for
this project of $18,000 from a single donor who gave $14,000 outright, and
also submitted the winning bid of $2,000 each in the MAPS auction of the
two original art Doonesberry cartoons donated to MAPS by Garry Trudeau.
The remaining funds for the study were obtained from Dale Gieringer of
California NORML and Ed Rosenthal of Quick Trading and Ask Ed fame, both
of whom donated $5,000 each. Rounding out the sum, an additional $800 is
coming from numerous small donations to MAPS.

Sending the wrong message?

Some medical marijuana advocates have cautioned that this study could
"send the wrong message" that smoked marijuana is too risky to
use as is, thus slowing down or preventing altogether FDA-approval of
smoked marijuana in rolled cigarette form. To the contrary, I feel that we
should be able to acknowledge that for some patients, smoking marijuana
carries certain risks which are nevertheless exceeded by its therapeutic
benefits. Studying ways to possibly improve the delivery of marijuana
should not undercut the effort to secure prescription availability of
marijuana as rapidly as possible. On the contrary, this study might even
hasten the day that the FDA approves medical marijuana by reducing the
efficacy of arguments against it. Demonstrating scientifically that there
is a way to reduce the risks of smoking favorably alters marijuana's
risk/benefit ratio, improving its chances of securing FDA-approval. More
compelling reasons for this study are that we are exploring the use of
marijuana in AIDS patients whose immune systems are already compromised.
For some of marijuana's other medical applications, like spasticity,
patients may need to smoke marijuana every day of their life. It simply
makes good sense to see if the ratio of marijuana's therapeutic components
to tars and particulate matter can be increased through some simple sort
of water pipe.

Water pipe patent search

In preparation for this study, MAPS had a patent attorney conduct a patent
search of water pipes. The search indicated that more pipes than one might
have imagined had been patented. Some of the patented pipes were very
humorous. One was a combination water pipe/drink holder with separate
liquid containers for the drink and the water that would filter the smoke
(perhaps for those who can't decide if they prefer alcohol or marijuana).
Other designs were made to be more difficult to spill (a not uncommon and
messy problem), or involved an efficient way to refill the bowl though the
use of a separate chute filled with "expensive tobacco" that
deposited a measured amount into the bowl when a knob was rotated.

Only two of the pipes made health claims. One inventor installed a filter
in the inhalation tube between the water bowl and the mouthpiece. No
evidence was presented indicating that the filter selectively filtered out
particulate matter as opposed to simply reducing both particulate matter
and THC. The other designer placed stones in the water to lengthen the
path of the smoke through the water. Once again, there was no evidence
that this actually increased the amount of filtering done by the water.

Putting pipes to the test

Previous studies, reported by Nick Cozzi in the last issue of the MAPS
newsletter, have demonstrated that water pipes do filter some of the
potentially harmful constituents of marijuana smoke. Dr. Hoffman's study
will be the first to quantify the specific components that various smoking
devices filter out of marijuana smoke. What we seek to determine are the
exact differences, if any, in the amounts of THC, other cannabinoids, tars
and particulate matter contained in water-filtered smoke compared to
unfiltered smoke.

The study has two phases. First, smoke from three different types of pipes
will be tested in a rough, quick way to determine their relative amounts
of THC and one representative tar. Second, the water pipe that delivers
the highest THC/tar ratio will then be run through a very comprehensive
analysis comparing the materials in the smoke from the water pipe to the
materials in the smoke from a standard unfiltered marijuana cigarette.

The three pipes to be tested in the first phase of the study are quite
different from each other. The first is a rather interesting water pipe
with a small battery operated fan blade immersed in the water. The fan
blade creates turbulence in the water in order to increase the mixing of
the smoke with the water. Theoretically, this should result in more
filtering action than if the water was still. The second water pipe is
being designed by Nick Cozzi and a MAPS member who was inspired by Nick's
article to see if he could design an efficient water pipe that would
incorporate various filters. Nick will suggest the filters (a gas
diffusion frit and a cigarette-type particulate filter) and the MAPS
member will build the prototype.

The third pipe that will be tested is not a water pipe. This pipe exploits
the fact that THC and other cannabinoids will vaporize at a temperature
below that of the burning point of marijuana. The pipe enables people to
inhale marijuana vapor containing THC and other cannabinoids rather than
marijuana smoke containing THC along with all sorts of particulate matter,
tars, and some gaseous products of combustion. This pipe is likely to
produce very little particulate matter and deliver little or no
undesirable gas combustion products.

The pipe uses an electric heating plate rather than matches. It works by
heating the marijuana enough to vaporize the THC. It then gathers the
vapor in an enclosed space and delivers the vaporized smoke to the smoker
through a standard mouthpiece. While this pipe is likely to be the best
from a health standpoint, it will probably take some further refinement
before it can be made easy to use, reliable, and efficient in terms of
getting as much of the THC out of the marijuana as possible. Because of
the more practical nature of the water pipes compared to the vaporization
device, we will conduct the comprehensive test with whichever water pipe
performs the best in the initial trial.

Harm reduction

This water pipe study is a classic example of the harm reduction approach
to drug use. If water pipes really reduce the harm associated with
marijuana smoking, non-medical users can be educated about the benefits of
water pipes and encouraged to use them whenever possible. Since smoking is
one of the main harms associated with the use of marijuana (accidents are
another), this simple water pipe study may help lay the groundwork for
significantly reducing the harmfulness of marijuana smoke. If US drug
policy ever moves to a harm-reduction approach to marijuana, studies such
as this one will play an important role in helping users to identify and
minimize the health risks of marijuana. The shift to prevention rather
than treatment is consistent with the current health care debate and seems
likely to reduce costs in the long run.

After over a year of effort, the MAPS study of the effectiveness of water
pipes in filtering marijuana smoke is about to begin. I would like to
express my deep appreciation for the generosity of the MAPS member who
believed in the importance of this study, and in putting this matter to a
scientific test.